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September 19, 2022

Is physician burnout a risk to patient safety?

Daily Briefing

    Burnout among physicians is associated with job dissatisfaction and poorer quality care for patients, as well as an increased number of safety incidents, according to a new meta-analysis published in The BMJ.

    Study details and key findings

    For the meta-analysis, researchers examined 170 observational studies that included 239,246 physicians, primarily from the United States or United Kingdom.

    According to the researchers, burnout was defined as "a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalization, and a sense of ineffectiveness and little personal accomplishment." Physicians self-reported their feelings of burnout through the Maslach Burnout Inventory or an abbreviated version of it.

    The studies assessed both career engagement and patient care outcomes. Some measures of career engagement included career choice regret, career development, job satisfaction, and turnover intention. Measures of patient care outcomes included patient safety incidents, patient satisfaction surveys, professionalism, and productivity.

    Overall, the researchers found that burned out physicians had an almost four-fold decrease in job satisfaction and were more likely to regret their career choice. These physicians were also three times more likely to have thoughts or intentions to leave their jobs, particularly if they reported their "emotional exhaustion" as being high.

    Burnout and job dissatisfaction were highest among physicians working in hospitals, particularly those in emergency medicine and intensive care, as well as among physicians between the ages of 31 and 50.

    As burnout increased, physicians were also less likely to maintain their professionalism and have less satisfied patients. This was especially true for physicians who experienced high "depersonalization" as part of their burnout.

    When it came to patient safety, burnout was associated with twice the number of patient safety incidents. This association was strongest among physicians ages 20 to 30 and those working in emergency medicine.

    "Burnout is a strong predictor for career disengagement in physicians as well as for patient care," the researchers wrote. "Moving forward, investment strategies to monitor and improve physician burnout are needed as a means of retaining the healthcare workforce and improving the quality of patient care."

    Commentary

    Latifa Patel, chair of the British Medical Association's representative body, said the meta-analysis's findings show that "[b]urnout is not just a question of personal wellbeing or career satisfaction—it is a matter of patient safety."

    "Tired, undervalued and understrength doctors cannot work to the best of their abilities and these figures throw into disturbing relief what that means for patient care," she added. "Doctors want to do the best by their patients but that is becoming increasingly difficult as they tackle record backlogs, regularly missing rest breaks, going without food breaks, and working themselves to their very limit often at the detriment to their own health."

    In an accompanying editorial, Matthias Weigl from University Hospital at Bonn University in Germany, wrote, "The mental well-being of physicians is vital for safe healthcare systems."

    "The pervasive nature of physician burnout indicates a defective work system caused by deep societal problems and structural problems across the sector," Weigl said.

    Going forward, Alexander Hodkinson, one of the study's authors from the United Kingdom's National Institute for Health and Care Research, said he plans to conduct a focus group study on interventions to combat physician burnout. According to Hodkinson, any interventions should come from and be tailored to health care organizations, such as hospitals or clinics.

    "Burnout tends to cluster at practice level," he said. "So, we find that when a certain number of doctors have high levels of burnout, it will be a high chance that there'll be other doctors in that practice that are also suffering from the same issue."

    Overall, "[i]f we don't act now sadly many more passionate and committed doctors will become burnt out and disillusioned, others will choose to leave the medical profession, resulting in a loss of expertise for patients and even more pressure on stretched resources," said Rob Hendry, medical director at the Medical Protection Society in the United Kingdom. (Putka, MedPage Today, 9/15; Pickover, The Press Association/Bloomberg, 9/14; Gleeson, Becker's Hospital Review, 9/15)

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